A narrative review of phthalates: From environmental release to kidney injury

Plastic products play an indispensable role in human daily lives, largely due to their low cost and unrivaled convenience. Phthalates (PAEs) are the most significant plastic additives due to their distinctive properties and are extensively utilized and produced in large quantities. Nevertheless, given their inability to form covalent bonds with plastics, these compounds are prone to leaching from plastic surfaces. As a result, the use of plastics in various industries has become a major source of PAEs in the environment, leading to increased risks to humans. The kidneys, which play a central role in the excretion of PAEs, are considered one of the primary target organs for PAEs accumulation and toxicity. A growing body of evidence supports an association between exposure to PAEs and adverse effects on the kidney. In environments, PAEs are often exposed simultaneously with other contaminants that may directly or indirectly modify the toxic effects of PAEs. This review focuses on the adverse effects of PAEs exposure on the kidney and their mechanisms of action, as well as the interactions between PAEs and other contaminants on the kidney. This review underscores the necessity for future toxicological studies to prioritize the mechanisms of renal injury caused by co-exposure to PAEs and other pollutants. The employment of advanced technologies, including network toxicology and molecular docking techniques, is imperative to enhance comprehension of the potential toxicity associated with co-exposures.